Endocrine Flashcards
1
Q
Acromegaly - symptoms by systems
A
General:
- change in apperance - course features
- excessive sweating
- tiredness
- deep voice
- daytime somnolence (OSA)
Neuro:
- headache
- visual disturbance - bumping into objects (bitemporal hemianopia
- carpal tunnel/other impinged nerves
MSK
- joint pains
- increased size of hands + feet
- proximal myopathy
Gastro:
- change in bowel habit/rectal bleeding - increased risk of bowel malignancy
Endo:
- weight gain
- galactorrhea
- amenorrhoea
- polyruria/polydipsia (diabetes)
- impotence/loss of libido
2
Q
Definition of Acromegaly
Ways people present with Acromegaly
A
Somatotroph adenoma producing excess growth hormone
Present with
- change in appearance
- bitemporal heminaopia
- diagnosis made by observation in clinic
3
Q
Management of Acromegaly
A
- Medical
- somatostatin receptor antagonist = Ocreotide - Surgical
- transphenoidal pituitary resection - Radiotherapy
- pituitary radiotherapy - Management of complications
- diabetes control
- hypertension control
- treatment of cardiomegaly - heart failure medications, ICD
- regular colonoscopies to monitor for polyps
4
Q
Clinical features of acromegaly
A
- General appearance
- course features
- sweating - Hands
- large hands (spade like)
- sweaty hands (active disease)
- swollen fingers, no rings
- loss of sensation and thenar eminance wasting - median neuropathy
- evidence of BM testing - Head + neck
- kyphosis - osteoporotic fractures
- proximal muscle weakness
- oedematous eyelids
- prominent supra-orbital ridges
- bi-temporal hemianopia
- marked enlargement of nose and ears
- proganthism - protrusion of lower jaw
- macroglossia
- poor dentition
- widened interdenticular spaces
- surgical scars: transphenoidal scar. transcranial scar - Chest + abdomen
- gynaecomastia
- displaced apex beat (cardiomegaly)
- acanthosis nigricans
- multiple skin tags
- check BP
- hepatosplenomegaly
- abdominal mass - bowel Ca - Lower limbs:
- stand up with arms crossed - assess for proximal myopathy
Extra tests:
- urine dip for glycosuria
5
Q
Investigations of Acromegaly
A
- Blood tests:
- IGF-1: raised in Acromegaly
- Glucose tolerance test: GH is NOT suppressed by 75mg oral glucose
- pituitary bloods: LH/FSH, ACTH, TSH, Prolactin - Imaging:
- MRI pituitary - Visual field testing - bitemporal hemianopia
6
Q
Cushings disease
A
ACTH dependent
- pituitary adenoma
- ectopic ACTH - small cell lung cancer
- exogenous ACTH administration
ACTH independent
- adrenal adenoma
- adrenal hyperplasia
- steroid use
- alcoholism
7
Q
Cushings disease - symptoms by systems
A
- General:
- weight gain
- loss of hair
- hirsutism
- thin skin/easy bruising
Endocrine:
- amenorrhoea
- poor libido
- polyuria/polydipsia
MSK
- myopathy
- back pain
- achilles tendon rupture
Neuro/Psych
- depression
- psychosis
8
Q
Cushings signs on examination
A
- Skin + hair
- plethoric
- abdominal striae
- thin skin
- acne
- hirsutism
- bruising
- frontal balding - Size
- buffalo hump
- moon face
- central obesity
- oedematous - Other
- HTN
- Pathological fracture
- Osteoporosis
- Proximal myopathy
- Glycosuria
9
Q
Cushings disease - investigations
A
- Suppression tests for confirmation
- overnight dexamethasone suppression test
- -> low dose: doesn’t suppress Cushings syndrome (primary hypercortisolism) - cortisol not suppressed but ACTH is low/undetectable
- -> high dose: Cushing’s disease - cortisol suppressed by high doses with normal to elevate ACTH - 48 hour low dose dexamethasone suppression test
- Work out cause
- plasma ACTH
- MRI pituitary
- CT CAP: adrenal adenoma, small cell lung cancer
10
Q
Addison’s disease - cause
A
- Autoimmune disease - anti-21 hydroxylase
- associated with hasimoto’s, pernicious anaemia, graves, type 1 diabetes, vitiligo - Infection = TB
- Vascular = adrenal haemorrhage: post-partum, meningococcal septicaemia, anti-phospholipid disease, SLE
- Infiltrative: cancer, amyloid
11
Q
Addison’s disease - investigation
A
- Short syncathen test
- 9am serum ACTH
- Auto-antibodies
- CXR - TB
- CT CAP - cancer, adrenal haemorrhage
- U&E - hyperkalaemia hyponatraemia
12
Q
Hyperthyroidism - causes
A
Common:
- Grave’s disease
- Toxic multinodular goitre
- Toxic adenoma
Uncommon:
- De Quervain’s thyroiditis
- Postpartum thyroiditis
- Gestational thyrotoxicosis
- Drugs - amiodarine, levothyroxine excess
- Exogenous iodine - contrast, in food
Rare:
- TSH secreting pituitary tuour
- ectopic thyroid tissue
13
Q
Grave’s eye disease - different ways to cause visual issues
A
- Corneal ulceration
- Optic atrophy secondary to extrinsic compression of optic nerve by excess fat deposition in orbit
- Ophthalmoplegia
- Loss of colour vision
14
Q
Hypothyroidism - causes
A
- Primary atrophic hypothyroidism
- Hashimoto thyroiditis
- post thyroidectomy/iodine therapy
- Drugs - amiodarone, carbimazole, lithium
- Hypopituitarism
15
Q
Hypopituitarism - causes
A
- Hypothalamus
- tumour
- infection - meningitis
- vascular - stroke
- genetic - Kallman’s syndrome (hypogonadotropic hypogonadism) - Pituitary stalk
- trauma
- tumour - craniopharyngioma
- carotid artery aneurysm - Pituitary
- tumour
- irradiation
- inflammatory
- infiltration - haematomachrosis, amloid, sarcoid, metastases)
- haemorrhage - pituitary apoplexy
